True Pacific independence

Papua New Guinea's Prime Minister, Michael Somare, does not like being "dictated to" by outsiders. When Canberra recently announced its latest rescue plan for PNG - an ambitious mix of security and financial support under somewhat paternalistic supervision - Port Moresby snapped back that it could find friends elsewhere.

One such candidate might be the Malaysian Prime Minister, Dr Mahathir Mohamad - no friend of Canberra, in particular, or the West in general. And the announcement that Dr Mahathir will lead a major Malaysian business mission to PNG may well tempt Sir Michael. Malaysia's economy has long outgrown aid dependency, allowing Dr Mahathir to famously dismiss Western lenders with a curt: "Thank you, we can do it ourselves." It is a line Sir Michael would like to be able to deliver himself.

Next year, Canberra will deploy several hundred Australian police to PNG, as well as placing expert staff inside key government departments. The aim is to assist PNG in restoring security and to prevent the loss of Australian aid funds to corruption or ineptitude. It is a highly interventionist model which will guide Australia's broader Pacific policy. Inevitably, its patronising overtones must ruffle nationalist and cultural sensitivities in a string of Pacific islands barely half a century beyond colonial rule. Over the past three decades, however, about $100 billion in mainly Western aid has enriched the Pacific's political elite without arresting the decline in living standards nor preventing the slide into lawlessness.

Not surprisingly, Port Moresby is keen to portray the Malaysian trade mission as a lever to reduce its dependency on Australian aid. Should Malaysia substantially expand its investments in oil, gas and timber, it could eclipse Australia as PNG's largest major trading partner. Whether such deals will generate the jobs and income PNG desperately needs is another question, as is the environmental cost. Rampant logging, mainly controlled by Malaysian companies, has already wrought serious damage to PNG's tropical forests. The stripping of PNG's natural resources by outsiders looks all too much like the shortsighted equivalent of selling off the family silver.

In reality, there is no quick fix for PNG's deep economic problems, or the violence which blights everyday life, Malaysian investment included. Australia's $350 million in annual aid represents 20 per cent of PNG's national income, a dependency PNG's politicians are right to resent but cannot do without. There is a real danger that any further stone throwing will deflect political energies from the fundamental reforms required to address PNG's malaise, and the Pacific's broader problems. These go beyond the challenge of corruption, to a host of practical measures such as the pooling of limited resources into regional transport and currency initiatives, for example.

For Australia, the Pacific represents a historic responsibility and a security threat on our sea borders. Weak nation states are vulnerable to exploitation by terrorist networks and international crime syndicates. It is self-interest, primarily, which drives Australia's new push for stable, accountable governance in the region. Ultimately, however, it is the people of the Pacific who have the most to gain from such reforms.

The politics of natural birth

Vagina is best - that has been the mantra of childbirth for many years. It is natural, it is less interventionist, it allows the woman to maintain control, it reduces costs, it reduces complications. Women have fought for the vagina, health groups have battled for it, and governments have supported it. But now a heretical idea has arisen - what if it is not so? What if a planned caesarean section is best?

The concept comes from smatterings of research which show that caesareans are getting safer, that cost differences may not be great, and that the complications of caesarean section (an abdominal wound plus all the small risks of surgery) may possibly be lower than the complications of a vaginal birth (lacerations, painful sex and later urinary incontinence). In a couple of situations - where the baby is breech (lying feet down) and where the woman has HIV - research has shown that babies benefit from their mothers having a planned caesarean section. But the question is now being asked: would this be true of the standard, head-down, full-term baby?

It is a question worth asking, simply because women and policymakers deserve to know everything possible about the impending birth. Which has the greater chance of delivering a healthy baby? Which produces fewer short- and long-term complications for all? Is there a difference in emotional impact? Is there a cost difference?

Such a study is being proposed in the United States, but some fear the consequences of a caesarean being shown to be safer. More caesareans means less control for women, more intervention, more antibiotics, a possible de-skilling of midwives and obstetricians (who may forget how to deal with difficult vaginal births that will still occur) and a further medicalisation of a natural process. But politics aside, if elective caesareans lead to greater chances of healthy babies and healthy women, then that should be known. Women could have the choice.

This is not an easy question to ask as it challenges so many assumptions. In the wider field of health care there are many similar questions. Do private hospitals provide better care than public ones, or just better meals? Do specialists guarantee better results than registrars, who are specialists in training? Does private insurance offer any advantages in health - rather than financial or emotional - terms? They all deserve an answer.